Obstructive sleep apnea and incidence of postoperative delirium after elective knee replacement in the nondemented elderly.
Obstructive sleep apnea and incidence of postoperative delirium after elective knee replacement in the nondemented elderly.
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DOI：
10.1097/aln.0b013e31824b94fc
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发表时间：
2012-04
期刊：
影响因子：
8.8
通讯作者：
Kwatra MM
中科院分区：
文献类型：
--
作者：
Flink BJ;Rivelli SK;Cox EA;White WD;Falcone G;Vail TP;Young CC;Bolognesi MP;Krystal AD;Trzepacz PT;Moon RE;Kwatra MM
术后谵妄是老年人的常见并发症，可发生在任何类型的手术后，并与发病率和死亡率增加有关;它也可能与随后的认知问题有关。由于术后谵妄的病因可能是多种多样的，有效的治疗仍然是一个难题。对接受择期膝关节置换术的≥ 65岁患者的术后精神障碍诊断和统计手册-IV谵妄进行前瞻性评价。排除标准包括痴呆、简易精神状态检查评分<24、谵妄、临床显著的CNS/神经系统疾病、当前酒精中毒或任何严重的精神疾病。在术后第2天和第3天使用标准化量表评估谵妄。从病历中获得患者的既往病史。阻塞性睡眠呼吸暂停（OSA）的发生是通过联系患者检查他们的多导睡眠图记录来证实的。使用Pearson卡方检验或Wilcoxon秩和检验和校正协变量影响的多元logistic回归分析数据。在106例入组患者中，27例（25%）发生术后谵妄。在15例阻塞性睡眠呼吸暂停患者中，8例（53%）发生了术后谵妄，而无阻塞性睡眠呼吸暂停的患者中有19例（20%）发生了术后谵妄（p=0.0123，OR：4.3）。在多变量分析中，阻塞性睡眠呼吸暂停是术后谵妄唯一有统计学意义的预测因素。这是第一个前瞻性研究，采用有效的措施谵妄，以确定之间的联系，既存的阻塞性睡眠呼吸暂停和术后谵妄。
Postoperative delirium, a common complication in the elderly, can occur following any type of surgery and is associated with increased morbidity and mortality; it may also be associated with subsequent cognitive problems. Effective therapy for postoperative delirium remains elusive because the causative factors of delirium are likely multiple and varied. Patients ≥ 65 years old undergoing elective knee arthroplasty were prospectively evaluated for postoperative Diagnostic and Statistical Manual of Mental Disorders-IV delirium. Exclusion criteria included dementia, mini-mental state exam score<24, delirium, clinically significant CNS/neurological disorder, current alcoholism, or any serious psychiatric disorder. Delirium was assessed on postoperative days 2 and 3 using standardized scales. Patients’ pre-existing medical conditions were obtained from medical charts. The occurrence of obstructive sleep apnea (OSA) was confirmed by contacting patients to check their polysomnography records. Data were analyzed using Pearson Chi-Square or Wilcoxon Rank Sum tests and multiple logistic regressions adjusted for effects of covariates. Of 106 enrolled patients, 27 (25%) developed postoperative delirium. Of the 15 patients with obstructive sleep apnea, 8 (53%) experienced postoperative delirium, compared to 19 (20%) of the patients without obstructive sleep apnea (p=0.0123, OR: 4.3). Obstructive sleep apnea was the only statistically significant predictor of postoperative delirium in multivariate analyses. This is the first prospective study employing validated measures of delirium to identify an association between pre-existing obstructive sleep apnea and postoperative delirium.